title: Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures.
abstract: OBJECTIVE
  The purpose of this study was to compare femoral head placement, rates of reoperation and cephalic implant cut-out of a screw versus a blade for patients over age 60 with low energy trochanteric fractures (AO/OTA 31-A1, A2, and A3) treated either with sliding hip screw or cephalomedullary nail.
  
  
  METHODS
  After surgeon selection of either hip screw or nail, hip screw patients were randomised to either a DHS (dynamic hip system screw) or DHS blade (dynamic hip system blade), while nail patients were randomised to either a Gamma3 Trochanteric Nail or a PFNA (proximal femoral nail antirotation). This resulted in a screw group (DHS and Gamma nail), and a blade group (DHS blade and PFNA). Outcome measures included tip-apex distance and zone location of the cephalic implant, as well as reoperation and implant cut-out within the first postoperative year.
  
  
  RESULTS
  A total of 335 patients were randomised, 172 to a screw and 163 to a blade. There was no significant difference concerning mean tip-apex distance, percentage of patients with a tip-apex distance >25 mm, and patients with a centre-centre position of the cephalic implant. There were 137 patients in the screw group and 132 in the blade group available for follow-up. They did not differ regarding rates of reoperation or cut-out (screw group = 2.9%; blade group = 1.5%).
  
  
  CONCLUSIONS
  Both a screw and a blade performed equally well in terms of implant placement in the femoral head and outcome.
authors.affiliation: Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland. richard.stern@hcuge.ch
authors.forename: Richard
authors.initials: R
authors.lastname: Stern
authors.forename: Anne
authors.initials: A
authors.lastname: Lübbeke
authors.forename: Domizio
authors.initials: D
authors.lastname: Suva
authors.forename: Hermes
authors.initials: H
authors.lastname: Miozzari
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D020127:Recovery of Function